New Vendor

Credit Application to be sent to who? *

Vendor Name *

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

DUNS Number *

Member of Unipro *

Yes
No

Federal Tax ID *

Telephone *

Fax

Contact Name *

Comments

Supplier Terms *

## Days

Discount *

Yes
No

Discount Percentage

0-100

Minimum Shipment Amount

Lead Time

Order Day

Delivery Day or Days

Picking Discount

Cut-Off Time

Broker Name

Broker Address Line 1

Broker Address Line 2

Broker City

Broker State

Broker Zip/Postal Code

Broker Telephone

Broker Fax

Broker Cell

Broker Email

Broker Contact Name

Broker Comments

How are orders placed?

Are Confirmations Provided?

Yes
No

If yes, how?

Additional Contact Information

Additional Information

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